Glycemic control not improving in youth and young adults with diabetes
medwireNews: Glycemic control in youth and young adults with diabetes has not improved with time, and in some cases has worsened, despite more aggressive glycemic targets and increased availability of newer diabetes technology and therapies, shows the SEARCH for Diabetes in Youth Study.
Speaking at the virtual ADA 80th Scientific Sessions, Faisal Malik, from the University of Washington School of Medicine in Seattle, USA, said the analysis of data on 6492 participants with a diabetes duration of more than 1 year “further underscores the urgent need for effective treatment strategies to improve metabolic status in youth and young adults with diabetes.”
This is particularly important because it is well recognized that lower glycated hemoglobin (HbA1c) levels in these individuals are “associated with lower risk and rate of microvascular and macrovascular complications,” he added.
Malik reported that, among participants with type 1 diabetes, mean HbA1c was 8.6% (70 mmol/mol) in the period 2002–2007, and statistically significantly higher in 2008–2013 and 2014–2019, at 8.9% (74 mmol/mol) and 8.7% (72 mmol/mol), respectively, after adjustment for study site, age, sex, race/ethnicity, health insurance status, and disease duration.
Of note, there was a significant temporal trend for worse glycemic control among participants with a diabetes duration of 5 to 9 years, with mean HbA1c increasing from 8.7% (72 mmol/mol) in 2002–2007 to 9.0% (75 mmol/mol) and 9.2% (77 mmol/mol) in 2008–2013 and 2014–2019, respectively.
For type 2 diabetes, there was no significant difference between the three time periods overall, with mean HbA1c at 8.7% (72 mmol/mol), 8.4% (68 mmol/mol), and 8.5% (69 mmol/mol) in 2002–2007, 2008–2013, and 2014–2019, respectively, but there was a difference among those with a diabetes duration of 10 years or more. In this group, mean HbA1c was 7.9% (63 mmol/mol) in 2008–2013, increasing to 10.0% (86 mmol/mol) in 2014–2019.
When the researchers analyzed the data by participant age they found that mean HbA1c levels in type 1 diabetes participants in the 10–14 years, 15–19 years, and 20–24 years age brackets were significantly higher in the current (2014–2019) cohort than in the earliest (2002–2007) cohort.
For type 2 diabetes, individuals aged 25 years and older had significantly higher mean HbA1b in 2014–2019 than in 2002–2007.
Malik concluded: “Future research should explore interventions that combine the use of efficacious diabetes technology with both effective behavioral and social approaches to improve glycemic control for the highly diverse group of US youth living with diabetes.”
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